Inequities in kidney health and kidney care

Abstract

Health inequity refers to unnecessary and unfair differences in the capacity to achieve optimal health and appropriate accessibility of care. Kidney diseases [including acute kidney injury (AKI) and chronic kidney disease (CKD)] have strong associations with inequity. This is largely due to the intrinsic risks of kidney diseases, the heavy burden of comorbidities and the high cost of therapies, e.g. for dialysis on wich survival for many may depend. However, inequities occur across the entire clinical course of kidney diseases. This review offers a comprehensive overview of the array of inequities in kidney health and kidney care, including inequities between countries, regions and social classes, inequities in healthcare, inequities specific to therapeutic modalities, and healtheconomic and ethical implications. This review also proposes solutions, which may inspire nephrology professionals to recognize and mitigate inequities. In addition to the main text that summarizes the relevant elements, and interested readers are referred to the comprehensive tables (including case stories) and references, which review some facets more deeply. It is the responsibility of all implicated to call attention to inherent risks of inequity in their immediate and broader environments, and to pursue the best possible solutions together with their communities. the one stop thing?"

Burden of renal anemia in 204 countries and territories, 1990-2021 : results from the Global Burden of Disease Study 2021

“…Lower HDI regions exhibit the opposite trend. Nevertheless, compared to low HDI areas, high HDI regions have more access to healthcare services of better quality, [20] permitting more timely diagnosis and treatment of renal anemia. This results in high HDI areas experiencing a higher incidence of renal anemia, yet disease burdens similar to those in low HDI areas.…”

Towards a better uptake of home dialysis in Europe: understanding the present and looking to the future

“…As discussed in depth by Vanholder et al . [ 51 ], it is the ethical responsibility of all nephrology professionals to reduce inequities in kidney care and improve patient outcomes. To move from the existing status quo of low use of home dialysis in the majority of European countries (all except those in Scandinavia), the key steps (i) for all those involved in dialysis delivery (clinicians, professional societies, healthcare management, dialysis industry) to recognize the inequity of access to home dialysis, (ii) advocacy by the nephrology community (clinicians, professional societies and people with kidney disease) to politicians and healthcare delivery administrators for expansion of home dialysis, (iii) for nephrology healthcare teams (clinicians supported by professional societies and management supported by healthcare funders) to embrace the principles of person-centered care thereby enabling people with advanced kidney disease to have education and choice of dialysis modality and (iv) improved care for older people, awareness of harm of ICHD and enabling PD by supporting assistance when needed.…”

Mind the Gap in Kidney Care: Translating What We Know into What We Do

“… 20 In low- or middle-income countries (LMICs), the gap between evidence and implementation is even wider given the high cost and inconsistent availability of these medications, despite availability of generics. 30 Such gaps in delivering optimal treatment for CKD are unacceptable.…”

“…4 Policies are required to integrate kidney care within essential health packages under universal health coverage ( Figure 4 ). 30 Multisectoral policies must also address the social determinants of health, which are major amplifiers of CKD risk and severity, limiting people’s opportunities to improve their health. 3 Lack of investment in kidney health promotion, along with primary and secondary prevention of kidney disease, hinders progress.…”